Adolescent Sexual Orientation and Suicide Risk: Evidence From a National Study | Stephen T. Russell, PhD, and Kara Joyner, PhD
Sexual orientation has emerged as a muchdebated risk factor for adolescent suicide in recent years. It is commonly believed that the difficulties of dealing with the stigma of homosexuality might lead to depression and even suicide among gay men and lesbians; this may be particularly heightened during adolescence, when emerging sexuality becomes a central issue in young lives.1 To date, more than 20 studies have addressed this question, using a variety of methods and samples. Owing to the methodological limitations of past studies, consensus has not been reached regarding the degree to which same-sex sexual orientation is a risk factor for suicide. In the mid-1980s, research reports began to suggest that the suicide rate was dramatically higher for gay and lesbian youths than for the general adolescent population. Debate about this issue was heightened in 1989 with the publication of the report of the US Secretary of Health and Human Services, which suggested that gay and lesbian youths are 2 to 3 times more likely to attempt suicide and that they account for up to 30% of the total adolescent suicide rate.2 Since that report, studies of gay and lesbian youths indicate that between 48%3 and 76%4 have thought of suicide, while between 29%3 and 42%5 have attempted suicide. The samples used in these studies were not random, however; the gay and lesbian youths represented in these research studies may have been at higher initial risk for suicide. Certainly these rates are much higher than those for the general adolescent population; recent studies report that between 19%6 and 29%7 of the adolescent population have a lifetime history of suicidal ideation, and between 7%6 and 13%7 report ever having attempted suicide. Several recent studies have used random samples of adolescents to study the association between adolescent sexual identity (identifying oneself as gay or lesbian) and suicidality (including suicidal thoughts or intentions, or suicide attempts). In a study involving a represen-
Objectives. Sexual orientation has been a debated risk factor for adolescent suicidality over the past 20 years. This study examined the link between sexual orientation and suicidality, using data that are nationally representative and that include other critical youth suicide risk factors. Methods. Data from the National Longitudinal Study of Adolescent Health were examined. Survey logistic regression was used to control for sample design effects. Results.There is a strong link between adolescent sexual orientation and suicidal thoughts and behaviors. The strong effect of sexual orientation on suicidal thoughts is mediated by critical youth suicide risk factors, including depression, hopelessness, alcohol abuse, recent suicide attempts by a peer or a family member, and experiences of victimization. Conclusions. The findings provide strong evidence that sexual minority youths are more likely than their peers to think about and attempt suicide. (Am J Public Health. 2001;91:1276–1281) tative sample of Minnesota high schools, suicidal intent and suicide attempts were found to be significantly higher among high school boys identified as homosexual or bisexual; there were no significant differences by sexual orientation for girls.8 Among a sample of 9thto 12th-grade students in Massachusetts, youths who identified as gay, lesbian, or bisexual were 3 times more likely than their peers to have attempted suicide in the past year.9 The fundamental criticism of past work on the link between same-sex sexual orientation and adolescent suicidality has been the inadequacies of samples to enable generalization10; most studies have been based on convenience samples of gay and lesbian youths, with no heterosexual control groups. Only very recently have representative random sample studies of adolescents included...
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